I authorize Solutions Parenting Support, its employees and Independent Contractors to collaborate with outside referral sources and outpatient therapists as documented only on the release of information form that I provide.

Disclosures*

I understand Solutions Parenting Support, its employees and Independent Contractors cannot be held responsible for being unable to access me due to telephone devices that may block their calls, my use of a pager system in which I cannot be directly reached, any form of caller identification, or any type of device that does not allow my parent coach to make direct telephone contact with me.

$2500.00 for a three month commitment, which includes 2.5 hours of individual coaching, 1 weekly call team or family therapy call if possible and 30 minutes of contact via email throughout the three month contract. For additional time in the week, the parent agrees to pay and additional $90 per hour.

Additional Comments and Special Arrangements*

I acknowledge that if monthly billing is needed AND agreed upon, the agreed upon payments will be due at the beginning of each month. Unpaid invoices will result in the suspension of future sessions. For clients who wish to continue with services AFTER the three month commitment, we have available 3 month, 1 month, as well as 3 or 5 prepaid session contracts, all at a discounted rate, for ongoing coaching services. These payments must be prepaid in advance to continue with scheduled sessions and services. Unpaid invoices will result in suspension of future sessions.